tbuckley/cabot-search huggingface dataset:
Abstract 13779: Metabolic Profiles Identify Distinct Cardiorenal Risk Factors in People With Diabetes Mellitus: Insights From the EXSCEL Trial
Authors: Daniel Edmonston, Maggie Nguyen, Jennifer Green, John Buse, Harald Sourij, Naveed Sattar, Adrian F Hernandez, Rury Holman, Svati H Shah, Robert J Mentz
Journal: Circulation (2022)

Introduction: Impaired fatty acid oxidation is common to both kidney and CV complications of diabetes mellitus (DM). We compared metabolic profiles of different cardiorenal trajectories to identify common pathways and unique signatures which may inform disease mechanisms. Methods The EXSCEL trial randomized patients with type 2 DM to exenatide vs placebo. For this study, we performed targeted metabolomics of 60 metabolites (45 acylcarnitines [ACs], 15 amino acids, ketone bodies, and nonesterified fatty acids) in 978 EXSCEL participants. Principal components analysis (PCA) was used for dimensionality reduction and multivariable logistic regression to examine the association of each PCA factor with four cardiorenal outcomes: CV (CV death, MI, or stroke), renal (≥30% eGFR decline, ESKD, or renal death), cardiorenal (both outcomes), or neither. We also evaluated the factors associations with hospitalization for heart failure (HHF) and new-onset albuminuria, adjusting for baseline CKD, medication, and treatment allocation. Results PCA metabolite factors and cardiorenal outcome associations are listed in Table 1. Considering the directionality of factor loadings, baseline levels of small-chain dicarboxylated ACs and medium-chain ACs were associated with worse cardiorenal outcomes. Long-chain ACs were associated with worse renal outcomes. In contrast, 12-month change in medium-chain saturated ACs and long-chain unsaturated ACs were associated with better CV and renal outcomes, respectively. No factors associated with albuminuria. Baseline nonesterified fatty acids (OR 0.64, 95% CI 0.42-0.99) and 12-month change in medium-chain ACs (OR 1.57, 95% CI 1.04-2.37) associated with HHF. Conclusions Baseline associations between ACs and adverse cardiorenal outcomes further link mitochondrial dysfunction with both disorders. However, the association between changes in some ACs with improved outcomes may suggest an adaptive role for these metabolites.
Abstract 14339: Differences in Clinical and Angiographic Characteristics Following Intracoronary Ergnovine and Acetylcholine Provocation Test for Coronary Artery Spasm
Authors: Seung-Woon Rha, Se Yeon Choi, Byoung Geol Choi, Jae Kyeong Byun, Jinah Cha, Byambasuren Battumur, Sujin Hyun, Soohyung Park, Dong Oh Kang, Eun Jin Park, Ji Bak Kim, Jin Oh Na, Cheol Ung Choi, Eung Ju KIM, Chang Gyu Park
Journal: Circulation (2022)

Background: Ergnovine (Erg) and Acetylcholine (Ach) are useful agents for assessing significant coronary artery spasm (CAS). However, comparison studies of the two agents are limited. Methods: A total of 8,093 consecutive patients (pts) who underwent Erg or Ach provocation test between November 2004 and June 2021 were enrolled. Significant CAS was defined as focal or diffuse severe transient luminal narrowing (&gt;70%) with/without chest pain or ST-T change on ECG. We divided into two groups according to provocation agent; 1) the Erg group (n=639), 2) the Ach group (n = 7,454). We investigated whether there are differences in clinical and angiographic characteristics according to intracoronary Erg or Ach provocation test. Results: Baseline clinical characteristics were similar between the two groups except the Erg group were more elderly (58.5 years vs 56.6 years, p &lt; 0.001) and dyslipidemia (36.0% vs 18.6%, p &lt; 0.001) but lower rates of current smokers (16.0% vs 21.1%, p = 0.002) and alcoholics (27.1% vs 32.9%, p = 0.002). During the provocation test, the higher rates of myocardial bridge, ECG change, chest pain, atrioventricular node block, and positive CAS results but lower rates of baseline spastic change were shown in the Ach group. More pts received to lower Ach dose and higher Erg dose during the provocation test. In CAS positive patients, the Ach group had higher rates of spasm in the left anterior descending artery and mid site, but lower proximal site (table). Conclusion: Clinical and angiographic parameters were different between Erg and Ach provocation tests. Further study would be needed to validate the different parameters and different positive rates between the two agents. Table. Angiographic and Procedural Parameters during Ergonovine versus Acetylcholine Provocation Test
Abstract 13481: Incidence of Post-Cardiac Injury Syndrome in Transcatheter and Surgical Aortic Valve Replacement
Authors: Betemariam Sharew, Jeffrey Shu, Wael A Jaber, Douglas Johnston, Samir R Kapadia, Jennifer Riggs, Rishi Puri, Grant W Reed, Amar Krishnaswamy, Allan L Klein, Paul C Cremer
Journal: Circulation (2022)

Introduction: Cardiac procedures and surgeries can cause injury to the pericardium and result in pericarditis, termed post-cardiotomy syndrome or post-cardiac injury syndrome (PCIS). The incidence of PCIS after transcatheter aortic valve replacement (TAVR) is unknown, and the aim of the current study is to compare the incidence of PCIS in surgical versus transcatheter aortic valve replacement (SAVR, TAVR). Methods: In a single-center retrospective cohort study of randomly selected patients who had TAVR or SAVR in 2019, the primary outcome was PCIS, defined according to ESC guidelines. Pericarditis recurrence was also defined according to ESC guidelines. Due to baseline differences in SAVR and TAVR patients, propensity score matching was performed using calipers of width equal to 0.2 of the standard deviation of the logit of the propensity score. Results: Patients undergoing TAVR (n=103) were older, had higher STS-PROM scores, and generally more co-morbidities compared to patients undergoing SAVR (n=100), with the exception of atrial fibrillation (Table). Overall, 17 patients (17%) with SAVR had PCIS compared to 1 patient (1%) with TAVR (p&lt;0.001). Ten patients (4.9%) were treated with pericarditis specific medications, of whom 7 (3.4%) received colchicine. Two patients (1.0%) developed recurrent pericarditis. In the sub-group (n=44) of propensity matched patients (Figure), 6 SAVR patients (27.3%) and no TAVR patients had PCIS. Conclusions: After TAVR, PCIS appears rare, which suggests that occult pericardial injury is uncommon. PCIS may also be less common after TAVR compared to SAVR, though larger studies are needed.
Abstract 13705: Catheter Ablation for Atrial Fibrillation in Patients With Heart Failure: An Update Meta-Analysis
Authors: Mohamed Gabr, Jorge Romero, Isabella Alviz, David F Briceno Gomez, Juan C Diaz, Daniel Rodriguez, Kavisha Patel, DALVERT POLANCO, Chintan G Trivedi, Sanghamitra Mohanty, Domenico G Della Rocca, Dhanunjaya R Lakkireddy, Andrea Natale, Luigi Di Biase
Journal: Circulation (2022)

Introduction: Increasing evidence has suggested improved outcomes in atrial fibrillation (AF) patients with heart failure (HF) undergoing catheter ablation (CA) as compared to medical therapy. We sought to investigate the benefit of CA on outcomes of patients with AF and HF as compared to medical therapy. Methods: A systematic review of PubMed, Embase, and Cochrane Central Register of Clinical Trials was performed for clinical studies evaluating the benefit of CA for patients with AF and HF. Primary endpoint was all-cause mortality. Secondary endpoints included atrial-arrhythmia recurrence and improvement in left ventricular ejection fraction (LVEF). Results: Eight randomized controlled trials were included with a total of 2121 patients (mean age: 65 ± 5 years; 72% male). Mean follow-up duration was 32.9 ± 14.5 months. All-cause mortality in patients who underwent CA was significantly lower than in the medical treatment group (8.8% vs. 13.5%, RR 0.65, 95% CI 0.51-0.83, P=0.0005). A 35% relative risk reduction and 4.7% absolute risk reduction in all-cause mortality was observed with CA. Rates of atrial-arrhythmia recurrence were significantly lower in the CA group (39.9% vs 69.6%, RR 0.55, 95% CI 0.40-0.76, P=0.0003). Improvement in LVEF was significantly higher in patients undergoing CA (+9.4 ±7.6%) as compared to conventional treatment (+3.3±8%) (Mean difference 6.2, 95% CI 3.6-8.8, P&lt;0.00001). Conclusion: CA for AF in patients with HF decreases all-cause mortality, improves atrial-arrhythmia recurrence rate and LVEF when compared to medical management. CA should be considered the treatment of choice to improve survival in this select group of patients. Central Illustration summarizing study outcomes. A) All-cause mortality; B) Change in left ventricular ejection fraction; C) Atrial-arrhythmia recurrence 1
Abstract 13109: Pacemaker Mediated Contact Allergy to Thiuram and Paraphenylenediamine
Authors: Vivek Menon, Anjula Chib, likhitesh jaikumar, Sasha Sharifi, Sophia Thang, Christopher Smith, Paul Volansky, MANDAR JAGTAP DO, Nanni Pidikiti
Journal: Circulation (2022)

Introduction: Allergic contact dermatitis to cardiac rhythm devices (CRD) has been reported sporadically from the early 1980s to present. Most of these cases involve allergic reactions to direct contact agents such as nickel, silicone, titanium, cobalt, epoxy resin, mercury, polysulfone, polyurethane and polychloroparaxylene. Our case is unique in that the strongest allergic reaction was with thiuram and P-phenylenediamine (PPD), which has only been documented once since the advent of permanent pacemakers (PPM) Case: 58-year old male with history of hypertension and coronary artery disease presented with palpitations and fatigue. Holter monitoring demonstrated tachybrady syndrome and he underwent dual chamber PPM implantation (L331 Accolade TM MRI - Boston Scientific Inc). Eight weeks later he presented with new onset rash around his neck and the surgical site. PPM allergy was suspected, as patient did not respond to empiric antibiotics. He underwent PPM and lead extraction. Decision was made to observe patient without immediate re-implantation of PPM. Skin patch testing was strongly positive to thiuram and PPD. Final diagnosis of allergic contact dermatitis was made and patient’s condition improved. Discussion: Thiuram and PPD, the raw materials used in the production of silicone rubber, encase pacemaker headers and leads. Individuals typically get sensitized to PPD by using hair dyes or temporary henna tattooing. The device used in our patient contained the same compounds. No studies to date document the true incidence and/or prevalence of allergic reactions to pacemaker components. One non-randomized retrospective trial reported benefits of skin patch testing before CRD implantation in patients who had a history of allergy to metals. Future trials are warranted to further evaluate the efficacy and benefits of pre-implantation skin testing and if it would benefit the population as a whole.
Abstract 14204: Impact of Concomitant Tobacco Use on Major Adverse Cardiovascular Events in Young Adults Hospitalized With Known Cannabis Use Disorder
Authors: Siva Naga S Yarrarapu, Shabnam Abrishami, Harshit Narula, Monika Singh, Ashwini Mahadevaiah, Rabiya Niaz, Mariam Aqeel, Memoona Saeed, Anjani Kumar Thota, Rupak Desai
Journal: Circulation (2022)

Introduction: Cannabis use disorder (CUD) and tobacco use disorder (TUD) are both independent CVD risk factors. However, with the increasing use of recreational cannabis use, the impact of concomitant TUD on major adverse cardiovascular/cerebrovascular events (MACCE) remains unexplored. Hypothesis: Evaluating the impact of concomitant CUD &amp; TUD on MACCE. Methods: We queried 2019's National Inpatient Sample to identify young adults hospitalized with CUD, with vs. without TUD. Baseline demographics, comorbidities, major adverse cardiac events, and the need for revascularization were compared. Multivariable regression analysis was performed, adjusting for confounders to assess the odds of MACCE. Results: Of 539125 patients with CUD, 288260 (53.5%) were TUD+ [median age 31 (25-37)]. TUD+ cohort often had males (60% vs 51.6%), white (58.1% vs 46.8%) patients than TUD- cohort (all p&lt;0.001). The TUD+ cohort showed higher rates of uncomplicated hypertension (15.0% vs 11.6%), alcohol abuse (21.0% vs 12.9%) but lower rates of obesity (9.2% vs. 11.6%), diabetes with chronic complications (4.5% vs. 5.4%), complicated hypertension (3.7% vs 4.4%) and metastatic cancer (0.2% vs. 0.5%) (all p&lt;0.001). After adjusting for covariates, the TUD+ arm had significantly higher odds of acute MI (OR:1.37), Acute PE (OR:1.46), Type 1-DM (OR:1.66), PCI (OR:1.78), CABG (OR:2.62) but lower odds of all-cause mortality (OR:0.55), cardiac arrest including VF (OR:0.59), AF (OR:0.67) and dysrhythmia (OR:0.75) (all p&lt;0.001) [Fig. 1]. The TUD+ cohort incurred lower hospital charges than TUD- cohort (p&lt;0.001). No statistical significance was observed in the odds of stroke and MACCE. Conclusions: Concomitant tobacco &amp; cannabis use had higher odds of Acute MI, PE, PCI and CABG but, interestingly, lower odds of all-cause mortality, dysrhythmia, AF and cardiac arrest including VF. The association between cannabis use and concomitant tobacco use on MACCE needs to be further studied.
Abstract 13324: Impact of Chronic Electronic Cigarette Vapor Exposure on the Recovery of Cardiovascular Function in Experimental Rat Myocardial Ischemia/Reperfusion Model
Authors: Wangde Dai, Jianru Shi, Lifu Zhao, Juan Carreno, Michael T Kleinman, David Herman, Rebecca J Arechavala, Samantha Renusch, Irene Hasen, Amanda Ting, Robert A Kloner
Journal: Circulation (2022)

Background: The impact of long-term electronic cigarettes (E-cig) vaping on cardiovascular function in rats were investigated. Methods: Sprague Dawley rats (both sex, 6 weeks old) were randomly exposed to filtered air (n=32), E-cig with nicotine (E-cig Nic + , n=26), E-cig without nicotine (E-cig Nic - , n=26), or standard cigarette smoke (n=31). After exposure to inhalation exposure for 8 weeks, the rats were subjected to 30 minutes of left coronary artery occlusion followed by 3 hours of reperfusion. Cardiovascular function was measured with intracavitary Millar catheters and echocardiography during the surgical procedure. Results: As the data shown in the Table, at 2.5 hours after coronary artery reperfusion, heart rate, cardiac output and positive/negative LV dp/dt were lower in the E-cig Nic + group compared to the air and/or cigarette group. LVFS in the cigarette group was higher than compared to E-cig Nic + or air group. There was a significantly higher systemic arterial resistance in the E-cig Nic + group compared to the cigarette group. Conclusions: Chronic E-cig Nic + exposure impairs the cardiovascular function recovery during the phase of coronary artery reperfusion after heart attack, indicated by reductions of heart rate, cardiac output, LV positive and negative dp/dt (suggesting a reduction in contractility and relaxation); and increase in systemic arterial resistance in the setting of experimental acute myocardial infarction compared to air and/or standard cigarette smoke.
Abstract 14177: Utilization of Optimal Guideline-Directed Medical Therapies Among Patients Newly-Diagnosed With Heart Failure and Reduced Ejection Fraction: An Analysis From the Optum Database (2016-2020)
Authors: Andrew Sumarsono, Luyu Xie, Chenguang Zhang, Stephen J Greene, Gregg C Fonarow, Jennifer T Thibodeau, MaryJane Farr, Mohammad S Khan, Javed Butler, Alanna A Morris, Muthiah Vaduganathan, Sarah Messiah, Ambarish Pandey
Journal: Circulation (2022)

Introduction: Optimal guideline-directed medical therapies (GDMT) improves clinical outcomes among patients with new-onset HFrEF. Limited data exist on achievement of optimal GDMT in the first 12 months among newly diagnosed patients with HFrEF. Methods: 2016-2020 OPTUM Claims Database, which includes privately insured and Medicare patients covered through the United Healthcare insurance, was used. Patients with new-onset HF were identified using validated ICD-10 codes and a 12-month look back to exclude prevalent HF. HFrEF patients were identified based on claims with ICD-10 codes of I50.2 and I50.4 within 6 months of HF diagnosis. Rates of optimal GDMT (≥50% target dose of ACEI or ARB or any dose of ARNI, ≥50% dose of beta-blocker, and any MRA) within 12 months of the incident HF diagnosis were compared overall and across race- and sex- groups. Adjusted Cox-proportional hazards models were used to evaluate the association of different patient-level factors with time to optimal GDMT during 12-month follow-up. Results: The study included 118963 patients with new-onset HFrEF (Age: 72 years, 15.8% Black, 57.4% Men). Only 8.3% achieved optimal GDMT during the 12 months after incident HF diagnosis. The optimal GDMT use within 12-months of HF diagnosis was low across the race-ethnic and gender groups ( Figure 1A/1B ). In adjusted Cox models, younger age, Black race, male sex, prevalent HF risk factors including hypertension, private (vs. Medicare insurance), and interval hospitalizations during the follow-up period were each associated with increased probability of achieving optimal GDMT ( Figure 1C ). In contrast, prevalent COPD, stroke/TIA, and polypharmacy were associated with a lower probability of achieving optimal GDMT. Conclusions: Utilization of optimal GDMT among patients with HFrEF is very low in the first 12 months after diagnosis. These findings highlight the need for aggressive implementation strategies to optimize GDMT utilization after new HF diagnosis.
Abstract 13627: Hepatic Venous Return to Lungs in Fontan is Dependent on Age-Dependent Caval Flow Ratio
Authors: Jocelyn Davee, Emily Eickhoff, Nikhil Thatte, Noah Schulz, Victor S S. Alemany, Meena Nathan, David Hoganson, Ashwin Prakash, Peter E Hammer, Pedro J del Nido, Rahul Rathod, Vijay Govindarajan
Journal: Circulation (2022)

Introduction: The Fontan procedure is performed between 2-4 years of age and is a palliative technique for patients born with single ventricle defects. The Fontan physiology is the result of a total cavopulmonary connection between superior and inferior vena cava (SVC and IVC) and the hepatic veins to the pulmonary arteries (PA). Maldistribution of hepatic blood flow to the lungs can result in the formation of pulmonary arteriovenous malformations (PAVM) and resulting cyanosis. Hepatic blood flow distribution (HFD) to right and left lungs is highly dependent on the local flow dynamics. We sought to investigate the impact of SVC-to-IVC flow ratio and age on HFD. Methods: SVC and IVC flow data measured by cardiac MRI (CMR) from 81 Fontan patients were collected to establish the relationship between SVC: IVC flow ratio vs. age. 3D Patient-specific computational fluid dynamics (CFD) modeling was performed for 5 patients who underwent Fontan procedure with an extracardiac conduit to quantify the HFD to the right and left PAs. We evaluated the dependency of HFD on SVC: IVC flow ratio by quantifying HFD to different SVC: IVC flow ratios (2, 1.0, and 0.5) for a given Fontan anatomy. Results: SVC: IVC flow ratio inverted at ~10 years of age (n=81, Figure A) indicating a clear shift to lower body predominance in overall caval flow. CFD analysis (n=5) showed that the shift in SVC-IVC flow had a significant effect on the HFD (Fig. B-F). Change in HFD was more substantial as SVC: IVC flow ratio shifted from 2 to 1 [~5-10 years] with an average % change of 21±6 compared to the HFD change that occurred for a shift of 1 to 0.5 [9±11 for ~10-20 years] (Fig. B-F). Conclusion: Well-balanced distribution of HFD is essential to prevent PAVMs and to ensure long-term efficacy of a Fontan. This study highlights how SVC: IVC flow ratios change over time and can impact HFD to PAs. Interventions to address HFD maldistribution should not be considered in isolation and should incorporate predictions of SVC: IVC changes over time.
Abstract 14303: Disparities in Mechanical Circulatory Support Utilization in Patients With End Stage Heart Failure
Authors: John Gharbin, Ahmed Brgdar, Adwoa B Winful, Pamela Alebna, Jin Yi, Abimbola Balogun, Prafulla P Mehrotra
Journal: Circulation (2022)

Despite optimum guideline directed medical therapy, one-year mortality rate of patients with end stage heart failure exceeds 50%. The use of mechanical circulatory support (MCS) has been shown to improve the overall quality of life in patients with advance stage heart failure. Studies have explored disparities in clinical outcome of patients undergoing mechanical circulatory support for acute myocardial infarction and cardiogenic shock. Data on sex-specific, racial, and socioeconomic disparities in patients with end stage heart failure requiring MCS as a bridge-to-transplant or destination therapy is limited. Using the most recent National Inpatient Sample database, we hypothesized that disparities found among other patient populations also exist in patients with end stage heart failure needing MCS. In our study, 1.5% of patients with end stage heart failure underwent MCS with a mean age of 55±16 yrs. Females accounted for 20.7% (20.69% vs 79.3%, p =0.002). Patients who received MCS had lower comorbities; Diabetes (38.8% vs 43.5%, p =0.308), COPD (8.6% vs 24.9%, p &lt;0.001), CKD (47.4% vs 63.1%, p =0.001), and Hyperlipidemia (43.1% vs 47.5%, p =0.347). Among patients with end stage heart failure, mean charlson index by race were 4.4 vs 4.6 vs 4.5 for Whites, Blacks, and Hispanics respectively, p =0.008. After controlling for age, comorbities, charlson index, insurance types, household income and place of residence, compared to Whites, Blacks and Hispanic with end stage heart failure were significantly less likely to undergo MCS (Blacks: aOR=0.50, 95% CI: 0.29-0.87, p =0.014) (Hispanics: aOR=0.68, 95% CI: 1.48, p =0.337). Females compared to males also had lower odds of receiving MCS in end stage heart failure (aOR=0.56, 95% CI: 0.34-0.92, p =0.021). We observed patients with end stage heart failure who received MCS were younger and had less comorbidities. After controlling for age, comorbidities and potential confounders, the odds of females and minority patients with end stage heart failure receiving MCS was about half. These findings underscore the importance of addressing social determinants of health in minority populations. Further implementation studies are required to help bridge the health equity gap in patients with end stage heart failure.